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Biomedical subjects

J A DeLisa

Publications and source records attributed to J A DeLisa.

At least 19 recordsLinked to original sources
PubMed2001

A history of cancer rehabilitation.

More than 8 million people in the United States have a history of cancer and more than 1 million new cancers are diagnosed each year. The 5-year survival rates for most tumors continue to improve due to earlier detection and treatment strategies. With increased cancer survival rates, there is a greater need for physiatrists (physicians trained in physical medicine and rehabilitation) to coordinate rehabilitation services and prepare a comprehensive plan for treatment and follow-up. Rehabilitation for patients with cancer should be no different from rehabilitation for other diagnostic conditions. The ultimate goal should be the achievement of the highest functional status possible within the limits of the disease and the patient's choices. Physiatrists have training that enables them to assess functional disability, biomechanics, quality of life, and human development, as well as the knowledge to prescribe appropriate medications, modalities, and orthotic, prosthetic, and assistive devices. An examination of the history of cancer rehabilitation will steer us toward future success for our patients. It is important that past lessons direct us away from pitfalls, and that patients receive the rehabilitation services to which they are entitled.

History, 20th Century↗
PubMed2001

The evolution of Medicare financing policy for graduate medical education and implications for PM&R: a commentary.

Currently, the only explicit payers for graduate medical education (GME) in the United States are the federal and state governments. Of these, Medicare is by far the largest and most predictable payer. Through the prospective payment system, Medicare reimburses teaching institutions for both their direct and indirect costs associated with their GME programs. Because a well-educated workforce benefits patients covered by private, as well as public insurance, various proposals have been advanced to establish an all-payer pool to distribute the financial burden more equitably. Furthermore, Medicare policy affects physician supply. There is increasing recognition of potential physician oversupply, raising policy questions about the government's longstanding support of GME. In comparison with other specialties, physical medical and rehabilitation (PM&R) may receive more favorable treatment under future GME funding plans, for 2 reasons. First, under the formulas used by Medicare, PM&R training slots typically bring in more indirect revenue to teaching hospitals than is consumed in indirect expenses. This makes PM&R a relatively more attractive program to retain in the face of mandated reductions in training slots. Second, in many parts of the country, PM&R is not threatened by oversupply, making cuts less likely. Nevertheless, the high percentage of non-US medical graduates entering PM&R training may make the specialty vulnerable to future reductions in funded training slots.

Education, Medical, Graduate↗
PubMed2001

The effect of changes in the health care environment on rehabilitation research: a survey of rehabilitation physicians.

OBJECTIVE: To assess what effect organizational, funding, and system changes in the health care environment may have on rehabilitation research. DESIGN: National survey. SETTING: Academic and clinical research programs. PARTICIPANTS: A total of 138 physicians participated in the survey. INTERVENTION: Mailed instrument requesting information on demographics, research activities, and indicators of change. MAIN OUTCOME MEASURES: Percentage of respondents reporting specific perceptions on (1) how academic and research programs are affected by organizational changes, (2) availability of research funds, and (3) the overall impact that health care changes have on research; between-group comparisons on survey responses. RESULTS: Usable responses were obtained from 138 physicians (response rate, 42.5%). Responding physicians reported workplace changes that included organizational restructuring (32.6%), affiliation with managed care plans (24%), and staff decreases (45.9%). Over half (54.8%) indicated that facility changes had detracted from their abilities to conduct research. A third (34.8%) reported declines in numbers of inpatient beds, and 89.6% reported decreased length of stay (LOS). Decreased LOS was cited as detracting from ongoing research by 36.6% and as discouraging new research by 33.3% of respondents. Although not reflected in measures of scholarly productivity, 53.6% reported having less time to devote to scholarship and 48.5% reported decreased professional activities. Over two thirds (67.4%) of responding physicians indicated that health care system changes had a negative impact on current research, and 54.5% indicated that such changes made it less likely that they would pursue new research. CONCLUSION: Changes in the health care system have had a dampening effect on rehabilitation physicians' research pursuits.

Attitude of Health Personnel↗
PubMed2001

Measuring professionalism in a physiatry residency training program.

A 12-item questionnaire modeled after the one prepared by the American Board of Internal Medicine dealing with professionalism was distributed to 122 physiatry residents representing six training programs, of whom 59% (72) responded. The mean item score on the survey was 7.7 (SD = 1.0) on a scale from 1 to 10, where 10 represents the highest level of professionalism. The internal reliability of the questionnaire was found to be satisfactory (Cronbach's alpha = 0.75). A factor analysis of the questionnaire items resulted in three factors explaining 64% of the variance. These factors were: excellence, honor/integrity, and altruism/respect; Eigen values were 3.35, 2.37, and 1.31, respectively. These factors are similar to those obtained in the American Board of Internal Medicine survey. This similarity is a positive feature in ongoing efforts to develop a reliable tool for measuring professionalism in physiatry residency training.

Altruism↗
PubMed2001

Cost-effectiveness of screening x-rays at admission to acute rehabilitation after joint replacement surgery: a retrospective chart review.

OBJECTIVE: To investigate the cost-effectiveness of performing routine screening x-rays for patients on admission to an acute rehabilitation facility, after hip or knee replacement surgery, by reviewing the overall incidence of abnormal radiographic findings and determining their impact on patient care and outcome. DESIGN: A retrospective chart review study, in which 592 patients were admitted, after hip or knee replacement surgery, to three acute inpatient rehabilitation facilities under one system. RESULTS: Eight of 592 admissions revealed abnormal screening x-rays, for an overall incidence of 1.35%. All of the eight abnormal radiologic cases remained medically stable throughout their acute rehabilitation stay. The abnormalities did not alter the patients' medical management or length of stay. One case, which had demonstrated normal admission films, revealed a dislocated hip prosthesis on a follow-up x-ray, which was obtained as a result of new onset hip pain. The patient was subsequently transferred back to the acute care hospital for surgical correction. CONCLUSIONS: The authors found a relatively low incidence of abnormal admission x-ray findings; furthermore, the detection of abnormal admission films did not alter patient care or outcome. The results suggested that performing routine admission radiologic studies on all patients after joint replacement surgery or hemiarthroplasty may not be a cost-effective screening tool in rehabilitation.

Arthroplasty, Replacement, Hip↗
PubMed2001

Employment-seeking experiences of physiatry residents completing training during 1999.

Despite increasing the need for physiatrists, there is more pressure on physiatry departments and training programs to reduce the number of resident training slots. Of 321 residents completing their training in June 1999 and surveyed by questionnaire, 161 (50%) responded to the survey. The factors accounting for a successful job search were analyzed. Surveys of graduating residents can provide accurate information on job opportunities and career choices; this information can be compared with previous physiatry manpower projections. Increasing difficulty in the job search process signals that the supply of residents may exceed the demand.

Employment↗
PubMed1999

Evaluation and rehabilitation of patients with adult motor neuron disease.

Adult motor neuron disease (amyotrophic lateral sclerosis [ALS]) is a neurodegenerative disorder characterized by loss of motor neurons in the cortex, brain stem, and spinal cord, manifested by upper and lower motor neuron signs and symptoms affecting bulbar, limb, and respiratory musculature. Clinically, the disease course is characterized by progressive weakness, atrophy, spasticity, dysarthria, dysphagia, and respiratory compromise, ultimately resulting in death or mechanical ventilation in the vast majority of patients. Patterns of presentation and pathological features of the disease, along with clinical and electrophysiologic criteria for diagnosis, are discussed in this review. Since 8% to 22% of patients survive more than 10 years without ventilator use, meticulous medical and rehabilitation management is extremely important to ensure optimal health and quality of life in these patients. Major issues in the care of individuals with ALS include weakness and spasticity, impairments in activities of daily living and mobility, communication deficits and dysphagia in those with bulbar involvement, respiratory compromise, fatigue and sleep disorders, pain, and psychosocial distress. Research in ALS changes rapidly, but is currently focused on potential etiologic factors such as glutamate excitotoxicity, role of oxidative stress, autoimmunity to calcium channels, and cytoskeletal abnormalities, as well as related treatment initiatives including glutamate modulators, neurotrophic factors, antioxidants, antiapoptotic factors, and gene therapy. Recently, mutations in the gene encoding Cu/Zn superoxide dismutase were identified in a subset of familial ALS patients. Riluzole, a glutamate antagonist and Na-channel blocker, became the only drug currently approved for treatment of ALS after studies showed a small positive effect on survival. Until a definitive treatment or cure for ALS is found, the multifaceted rehabilitation team approach remains the best hope for improving health and survival in this devastating illness.

Activities of Daily Living↗
PubMed1999

Model Spinal Cord Injury System trends, and implications for the future.

In the 25 years since the federally designated Model Spinal Cord Injury Systems program was started, many changes have occurred. The systems have increased in number and location and have changed in composition. Data are available on approximately 19,000 acutely injured traumatic spinal cord injured individuals, with more than 117,000 total records. This volume of data allows analysis of many trends affecting the care of people with spinal cord injuries. The time span covered by the database allows comparison of various time periods, including the most recent decade--during which managed care has emerged as a dominant force in health care evolution. This article summarizes these trends, based on information in the articles in this special issue devoted to the Model Spinal Cord Injury Systems. Finally, this article offers an analysis of future implications for SCI care in general and the federally designated Model Spinal Cord Injury Systems program in particular.

Databases, Factual↗
PubMed1998

Mandatory clerkship in physical medicine and rehabilitation: effect on medical students' knowledge of physiatry.

OBJECTIVE: To study the effect of a 2-week clerkship on the perceptions and knowledge of physical medicine and rehabilitation (PM&R) among fourth-year medical students. DESIGN: Survey of fourth-year medical students before and after completion of a mandatory clerkship. RESULTS: Knowledge of PM&R by fourth-year medical students is marginal, but a clerkship increases the awareness of the practice of physiatry. CONCLUSIONS: Mandatory clerkships can help expose future physicians to the benefits of physiatric services and should be pursued by academic PM&R departments.

Career Choice↗